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Boat /Trip Waiver, Release and Indemnity Agreement

Evolution Ocean Scuba

Your Name:

Phone Number:                                                                Email:     

Emergency person to contact:

Their contact details:

 

Divers Qualifications / Experience

Dive Card No:

 

Date of Last Dive:

Highest Dive Qualification:

                

Maximum Logged Depth:

Certifying Agency:

Are you Comfortable Diving without a Dive Guide?          Yes  /  No

Total Number of logged Dives:

 

Are there any medical conditions that may need a doctors clearance   Yes  /  No

 

Have you ever had a problem related to your ears or sinuses?               Yes  /  No

 

Are you currently pregnant?            Yes  /  No

 

Will you be flying within 48 Hours of your last dive today              Yes  /  No

 

For all participants in scuba diving/snorkelling, Instruction and all other  water sports activities Evolution Ocean Scuba provides, the undersigned herby release and discharges Evolution Ocean Scuba, its agents and all employees from any and all claims for personal or property injury or damage or wrongful loss of life howsoever caused.

 

The undersigned for them self, their heirs, executors, administrators and assigns further releases for Evolution Ocean Scuba in the event of any claim for personal injury, property damage or wrongful loss of life resulting from his personal negligence and agrees to indemnify and save harmless Evolution Ocean Scuba from any and all claims or causes of action whomever made or presented or any other claim or potential claim of whatever nature.

 

I fully acknowledge that any form of Flu within the last 10 days, Colds, Epilepsy, any recent operations and the taking of most medications are reasons why I should not be SCUBA diving. I understand that any of these factors can result in an embolism and death even when all diving functions are performed correctly. I understand that as a diver a embolism necessitates urgent and immediate expensive emergency treatment.

I have completely read and fully understand all questions and statements above, and by which none of these factors above apply to me.

 

Signed_________________________________________ Date ___________________________

 

Parent / Gaurdian________________________________Witness__________________________

 

 
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General Inquiries: evolutionoceanscuba@bigpond.com